Contents

This is the removal of a small section of the tumour, the sample will be analysed by a histopathologist in order to establish a precise diagnosis. Surgical procedure. This may be a needle biopsy, where a very fine needle is used to take a tiny sample of the tumour. Occasionally a surgeon may remove the whole tumour prior to diagnosis; a resection biopsy.

is the branch of medicine that specialises in the study and treatment of blood and blood tissues (including bone marrow). A blood count is where the various types cells in the blood are
measured. This may aid diagnosis and will be used during
treatment to monitor toxicity. The Haematologist may also
examine samples from a bone marrow aspiration (needle into the
bone) and samples of spinal fluid from a lumbar puncture (needle
between the vertebra of the spine).

the study of cells relating to the disease. (Histology is the microscopic study of cells and tissues, Pathology is the study of the disease). The histopathologist will determine a precise diagnosis by laboratory tests and microscopic
examination of the cells.

is where normal cells
go through physical changes in order to form the different
specialised tissues of the body. Malignant cells may range from
well-differentiated (closely resembling the tissue of
origin) or undifferentiated or anaplastic (bearing
little similarity to the tissue of origin). In general it is the
undifferentiated or anaplastic histologies which are more
aggressive.

A substance in the body that may indicate the presence of cancer. Markers may be secreted by the tumour itself or produced by the body in response to the cancer. Tumour markers may aid diagnosis or give an indicator of how treatment is progressing.
These markers are usually specific to certain types of cancer. For example neuron-specific enolase (NSE) is associated with a number of types of cancers, in particular neuroblastoma. Also alphafetoprotein (AFP) levels are often abnormally high in patients
with Germ cell tumours.

X-ray Examination of X-ray films may indicate the
site and extent of the tumour and aid in the detection of
metastatic spread.

CT
Computed tomography (CT or CAT scan) makes a
cross-sectional x-ray picture of a "slice" of the body. The
machine rotates around the patient taking x-rays from different
angles, the images are then processed by a computer.

MRI Magnetic resonance imaging. This is used to
determine if the biochemical activity of a tissue responds
normally to magnetic forces, tumours may give an abnormal signal.

Ultrasound The use of sound waves to image the underlying structures of the body. Ultrasonic waves are reflected differently depending on the type of tissue they pass through, aiding the detection of abnormal tissues.

Staging is where the disease is categorised as to how far it has spread. The precise staging system used will depend on the type of cancer the patient has. In general low stage patients are those with localised tumours that are easily
resectable, whilst high stage patients are those with widespread metastases. The treatment given may largely depend upon which stage the patient is at diagnosis.

is the expected outcome
of a disease and it's treatment, this may be influenced by a
variety of factors such as stage, age, site etc. depending on
the particular type of cancer. For example, in general a patient
with localised disease may have a more favourable prognosis
compared to a patient with widespread disease which may be less
favourable.

Pre-operative chemotherapy - drugs given to shrink the tumour before surgery.

Complete resection this is where all of the tumour
has been totally removed during surgery, as opposed to an
incomplete resection. The surgical specimen may be examined by a
pathologist to determine if it is likely to have removed all of
the primary tumour. If there is any tumour left after surgery
this may be macroscopic (visible to the eye) or microscopic, in
either case radiotherapy may be needed to kill the remaining
tumour cells.

Since the 1960's the development and use of drugs has
dramatically improved the prognosis for many types of cancer.
Chemo- means chemicals, for most types of cancer chemotherapy
will consist of a number of different drugs, this is known as
combination chemotherapy. Chemotherapy may be given in a variety
of ways; Intravenously (IV) -into a vein is the most common,
Intramuscularly (IM) -injection into a muscle, Orally -by mouth,
Subcutaneously (SC) -injection under the skin, Intralesionally
(IL) -directly into a cancerous area, Intrathecally (IT)-into
the fluid around the spine, Topically -medication will be
applied onto the skin.

Cytotoxic - cytotoxic drugs kill or damage cells.
The normal cells of the body grow and die in a controlled way,
but cancer cells keep growing and multiplying. Chemotherapy
destroys cancer cells by stopping them from growing or
multiplying at one or more points during the life cycle of the
cell.

Central line - a thin plastic line into a vein in the
chest used for the delivery of chemotherapy e.g. HICKMAN® catheter.

Drug resistance is where tumour cells become
resistant to chemotherapy. Some tumour cells will be
chemo-sensitive and are killed by anticancer drugs; the cells
that remain are likely to be more resistant. Thus by selection
it is the most resistant cells survive and divide, they may be
resistant to a particular drug, a class of drugs, or all
drugs.

The bone marrow is destroyed by high dose chemotherapy and
possibly radiotherapy which has been given to kill malignant
cells in the body. Healthy matching marrow is then transplanted
into the patient.

Allogeneic BMT Healthy marrow is taken from a
matched donor and used to replace the patients bone marrow which
has been destroyed by high dose chemotherapy. The donor may be
a relative, if the patient has a twin this may be the best
match, otherwise a brother, sister, or another unrelated person
may donate marrow.

Autologous BMT In an autologous bone marrow
transplant the marrow is first taken from the patient. The
marrow is usually then purged with chemicals to kill any
malignant cells in it, and may then be frozen to preserve it.
High dose chemotherapy is given to the destroy the patient's
remaining marrow. The frozen marrow is then thawed and
transplanted back into the patient.

In the future patients might be immunised against their own
cancers by injecting them with their own tumour cells after they
have been genetically modified. The gene-modified tumour cells
may encourage the patients own immune system to destroy the
cancer cells. Tumour necrosis factor (TNF) and interleukin-2
(IL-2) are substances associated with the immune system which
encourage anititumour activity.

two general
approaches include a) the mass screening of thousands of natural
substances to see if they have any anti cancer potential; or b)
making new compounds in the laboratory e.g. creating analogues
of existing drugs (slightly modified chemical structures)
designed to make the drug more potent.

experiments may
be in vitro (in the test tube) or in vivo (in the body). Much
laboratory work uses cell cultures (cells grown in the lab);
either from established cell lines or from material
collected at biopsy/surgery.

There is a great
deal of research investigating the mechanisms of how drugs are
metabolised and absorbed by the body's cells. Growing knowledge
in this field provides the foundations for improving the
anticancer potential for existing drugs and for developing new
'designer' drugs. Other work includes research into the
machanisms of drug resistance.

cytogenetics.
During recent years there has been rapid advances in the
understanding of tumour biology at the genetic level. Research
into the genes associated with different cancers include the
identification of oncogenes, tumour supressor genes. This is a
key area of cancer research, providing a basis for the
development of new treatments and new diagnostic tools. In the
future treatment may be more tailored to the biological features
of the cancer rather than the standard clinical features.

Cells, Chromosomes and Genes

There are more than 100 trillion cells in the human body. Every cell (except the red blood cells) contain the entire human genome that is, all the genetic information necessary to build a human being. This information is encoded in the DNA.

Inside the cell's nucleus, DNA is tightly twisted and packed into 23 pairs of chromosomes (one chromosome in each pair comes from each parent).

There are 46 human chromosomes which are estimated to contain about 100,000 individual genes that determine each person's inherited human characteristics. Each gene is a segment of double-stranded DNA which holds the information for making a specific
molecule, usually a protein. This information (or code) lies in varying sequences of vast numbers of pairs of the four chemical bases that make up the DNA. A change in the sequence (a mutation), or missing sequences (deletion) of these bases may result in
an altered protein that does not work properly, or a failure to produce that protein altogether.

Some Studies are
experimental which make in intervention e.g. clinical trials, others are observational in which no
medical intervention is made. Studies may also be
prospective ie. ongoing into the future, or
retrospective ie. looking at historical data. In general
studies aim to test a hypothesis (theory) by disproving
null hypothesis (the opposite theory) e.g. in a trial of
a new drug the null hypothesis might be that the new drug has no
effect on survival.

Tests new
types of treatment and aim to define a safe dose that will be
used for further studies. This is usually the first testing of a
treatment on humans after extensive laboratory work. Recruitment
for Phase I trials are usually from patients for whom no other
effective therapy is known.

Compare one
or more treatments of proven efficacy. Often patients will be
randomised between an established 'standard' treatment and a new
'experimental' treatment - it is not known which is the better
treatment.

The study of
populations. Regional and National cancer registries record all
cancers enabling population based studies in cancer to be
carried out. Knowing how many people get a type of cancer out of
the overall population provides the information needed to
calculate incidence rates.

are where
cases are compared to controls, in order to avoid
bias the controls are matched for factors such as age and
sex. The aim is to investigate possible associations between
certain factors and risk of disease. For example a study
investigating smoking and the risk of lung cancer.